Hirsch H S, Lotke P A, Morrison L D
Hospital of the University of Pennsylvania, Philadelphia.
Clin Orthop Relat Res. 1994 Dec(309):64-8.
To determine the role of the posterior cruciate ligament in total knee arthroplasty, 242 consecutive primary total knee arthroplasties were included in 1 of 3 sequential groups. Group I included 77 Press Fit Condylar total knee replacements in which the posterior cruciate ligament was completely released from its tibial attachment. In Group II, there were 80 Press Fit Condylar total knee replacements in which the posterior cruciate ligament was retained. Group III consisted of 85 total knee replacements with a posterior cruciate-substituting device (Insall-Burstein II). All patients were observed at least 2 years and evaluated by the Knee Society's Clinical and Functional Scoring System, including a radiographic evaluation. No differences were found between the posterior cruciate ligament sacrificed group and the posterior cruciate ligament preserved group. The 1 significant difference among the 3 groups was in range of motion (ROM). Groups I and II averaged 103 degrees and 104 degrees motion respectively, whereas Group III, the posterior cruciate-substituting group, averaged 112 degrees (p = 0.001). In addition, only in Group III was the lower 95% confidence limit of the mean ROM > 90 degrees. These findings suggest that preserving the posterior cruciate ligament does not consistently lead to improved functional ROM. The posterior cruciate ligament-substituting device historically has demonstrated excellent survivorship and appears to offer greater ROM.
为确定后交叉韧带在全膝关节置换术中的作用，242例连续的初次全膝关节置换术患者被纳入3个连续组中的1组。第一组包括77例压配髁型全膝关节置换术，术中后交叉韧带从胫骨附着处完全松解。第二组有80例压配髁型全膝关节置换术，术中保留了后交叉韧带。第三组由85例使用后交叉韧带替代装置（Insall-Burstein II型）的全膝关节置换术组成。所有患者均接受至少2年的观察，并通过膝关节协会的临床和功能评分系统进行评估，包括影像学评估。后交叉韧带牺牲组和后交叉韧带保留组之间未发现差异。3组之间的1个显著差异在于活动范围（ROM）。第一组和第二组的平均活动度分别为103度和104度，而第三组（后交叉韧带替代组）的平均活动度为112度（p = 0.001）。此外，仅在第三组中，平均ROM的95%置信下限> 90度。这些发现表明，保留后交叉韧带并不能始终带来更好的功能性ROM。从历史上看，后交叉韧带替代装置已证明具有出色的生存率，并且似乎能提供更大的ROM。
